Factors influencing symptom appraisal and help-seeking of older adults with possible cancer: a mixed-methods systematic review

Abstract

Background: The burden of cancer falls predominantly on older adults. Prompt presentation to primary care with cancer symptoms could result in an earlier diagnosis. However patient appraisal and help seeking decisions involving cancer symptoms are complex and may be further complicated in older adults. Aim: To explore the effect of older age on patients’ appraisal of symptoms that may indicate cancer and their decision to seek help for these symptoms. Design: Mixed methods systematic review Method: Electronic databases were searched for studies on the appraisal and help seeking of cancer symptoms by adults aged 65 and over. Studies were analysed using thematic synthesis and according to the Synthesis Without Meta-Analysis (SWiM) guidelines Results: Eighty studies were included in the review with a total of 324995 participants. The studies suggested an association between increasing age and a prolonged appraisal interval. Factors such as reduced knowledge of cancer symptoms and differences in symptom interpretation may contribute to this prolonged interval. In contrast, we found an association between increasing age and prompt help-seeking. Themes affecting help seeking included the influence of family and carers, competing priorities, fear, embarrassment, fatalism, co-morbidities, a desire to avoid doctors, a perceived need to not waste doctor’s time and patient self-management of symptoms. Conclusions: This review suggests that increasing age is associated with delayed symptom appraisal. As a result of this review, policy makers, charities and information from GPs should aim to ensure older adults are able to recognise potential symptoms of cancer and can seek help promptly.

The relationship between patient enablement and help‐seeking in the context of blood cancer symptoms

“…Supporting this hypothesis, a recent systematic review found that self‐management of symptoms (e.g. watchful waiting or trying over the counter treatment before visiting the doctor) was a barrier to help‐seeking for cancer symptoms among older adults 24 …”

“…Our finding that older age was associated with increased likelihood of help-seeking and being comfortable to reconsult is also in line with the findings of the systematic review. 24 This has potential implications for younger peoples' experiences of help-seeking and reconsulting, particularly given the rise in incidence of early-onset cancers (i.e. cancers diagnosed in adults <50 years old).…”

“…watchful waiting or trying over the counter treatment before visiting the doctor) was a barrier to help-seeking for cancer symptoms among older adults. 24 Given the overlap between self-care, enablement and empowerment, 20 this may explain why those scoring higher on patient enablement were less likely to seek help when experiencing a potential blood cancer symptom, particularly as these symptoms are often vague and non-specific (e.g. fatigue) and self-management in the first instance may be appropriate.…”

Symptom appraisal and help seeking in males with symptoms of possible prostate cancer: a qualitative study with an ethnically diverse sample in London

“… 22 , 31 – 33 This may result in fewer proximal social cues (that is, everyday interpersonal interactions with friends, family, and colleagues) that help males to either recognise and understand the importance of their symptoms, or to seek help as a result of their concerns being legitimised and additional information being provided. 17 , 29 , 32 , 34 , 35 Overcoming cultural stigmas associated with prostate cancer and providing proximal social cues should, therefore, be a focus of future strategies for improving early presentation in Black males.…”

The Effect of Older Age and Frailty on the Time to Diagnosis of Cancer: A Connected Bradford Electronic Health Records Study

“…Existing co-morbidities or normal signs and symptoms of ageing may mask potential red flag symptoms of cancer, impairing both the patient’s and clinician’s recognition of these, thereby increasing time to referral [ 36 ]. For example, the eFI includes heart failure as a contributing factor to frailty [ 11 ].…”